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Duke Treadmill Score Calculator

Calculate the Duke Treadmill Score (DTS) from exercise stress test results. DTS = exercise time − (5 × max ST deviation) − (4 × angina index). Scores ≥5 indicate low risk (annual mortality <1%).

Concept Fundamentals
≥5
Low Risk
&lt;−11
High Risk
&lt;1% to &gt;5%
Annual Mortality

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Key values and context for this tool: • Low Risk: ≥5 • High Risk: &lt;−11 • Annual Mortality: &lt;1% to &gt;5%

Key values
≥5
Low Risk
Key value
&lt;−11
High Risk
Key value
&lt;1% to &gt;5%
Annual Mortality
Key value

Ready to run the numbers?

Why: Calculate the Duke Treadmill Score (DTS) for exercise stress test interpretation.

How: DTS = exercise time − (5 × ST deviation) − (4 × angina index). Scores stratify 5-year CV mortality risk.

Scores stratify 5-year CV mortality risk.

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📋 Quick Examples — Click to Load

Duration of exercise on treadmill
min
Max ST depression at 60–80 ms after J-point
mm
Angina during exercise
Patient age for context

For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.

The Duke Treadmill Score (DTS) stratifies 5-year cardiovascular mortality risk from exercise stress testing. DTS = exercise time (min) − (5 × ST deviation mm) − (4 × angina index). Scores ≥+5 indicate low risk (<1% annual mortality); ≤−11 indicates high risk (4–5%). Developed by Mark et al. 1991, validated by ACC/AHA and JAMA.

≥+5
Low Risk
<1%
Low Risk Mortality
1–4%
Intermediate Mortality
4–5%
High Risk Mortality

Sources: Mark et al. 1991, ACC/AHA, JAMA

Key Takeaways

  • • DTS combines exercise duration, ST-segment change, and angina into one prognostic score
  • • Longer exercise time improves the score; ST depression and angina worsen it
  • • High-risk scores (≤−11) warrant urgent cardiology evaluation and possible catheterization
  • • Low-risk scores support conservative management and exercise program initiation

Did You Know?

🔬 DTS was derived from 2,842 patients at Duke University Medical Center (Mark et al. 1991)
📊 Exercise time is the strongest predictor; each minute adds 1 point to DTS
💡 Angina index: 0 = none, 1 = non-limiting, 2 = exercise-limiting chest pain
🌍 ACC/AHA guidelines recommend DTS for risk stratification after stress testing
📈 5-year survival exceeds 99% for low-risk (DTS ≥+5) patients
🎯 High-risk patients (DTS ≤−11) have 4–5% annual mortality without intervention

How Does DTS Work?

Formula

DTS = exercise time − (5 × ST deviation) − (4 × angina index). Each component reflects myocardial ischemia and functional capacity.

Risk Categories

Low (≥+5): <1% annual mortality. Intermediate (−10 to +4): 1–4%. High (≤−11): 4–5% annual mortality.

Clinical Use

Guides further testing (stress imaging, angiography) and treatment intensity. High-risk scores often lead to invasive evaluation.

Expert Tips

Use Bruce or standard protocols; exercise time must be from the actual test
ST depression is measured at 60–80 ms after J-point; use the lead with maximum depression
Consider stress imaging when DTS is intermediate and clinical suspicion remains
Always interpret DTS with full clinical context; age and comorbidities matter

DTS Risk Categories

ScoreRiskAnnual Mortality
≥ +5Low<1%
−10 to +4Intermediate1–4%
≤ −11High4–5%

Frequently Asked Questions

What is the DTS formula?

DTS = exercise time (min) − (5 × max ST deviation in mm) − (4 × angina index). Angina index: 0 = none, 1 = non-limiting, 2 = limiting. Example: 9 min, 2 mm ST depression, no angina → DTS = 9 − 10 − 0 = −1.

What are the DTS risk categories?

Scores ≥+5 indicate low risk (&lt;1% annual mortality). −10 to +4 is intermediate (1–4%). ≤−11 is high risk (4–5% annual mortality) and warrants urgent cardiology evaluation.

How is exercise time interpreted?

Exercise time is the strongest predictor; each minute adds 1 point to DTS. Longer duration improves the score. Bruce or standard protocols are used; time must be from the actual stress test.

What does ST deviation mean?

ST-segment depression indicates myocardial ischemia. It is measured at 60–80 ms after the J-point; use the lead with maximum depression. More ST depression worsens the DTS (5 points per mm).

How is the angina index scored?

0 = no angina during the test. 1 = non-limiting angina (chest pain present but did not stop exercise). 2 = limiting angina (chest pain caused exercise to stop).

When is DTS used?

DTS is used after exercise stress testing to stratify coronary artery disease risk and guide further testing (stress imaging, angiography). It helps decide between conservative management and invasive evaluation.

Key Statistics

1991
Mark et al. original publication
99%
5-yr survival (low risk)
75%
5-yr survival (high risk)
3
Components (time, ST, angina)

Official Data Sources

Mark et al. 1991 (JAMA) ↗
Original DTS derivation and validation
ACC/AHA Guidelines ↗
Exercise stress testing guidelines
JAMA Network ↗
Peer-reviewed DTS studies
PubMed ↗
DTS and stress test literature

⚠️ Disclaimer: This calculator is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. DTS interpretation requires physician review of the complete stress test. Always consult a qualified healthcare provider.

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